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    Visual Monthly Inspections: Underground Storage Tank Systems

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    Parth Patel
    This document provides a checklist for monthly visual inspections of underground storage tank systems. It lists 17 items to inspect, including vent risers, spill buckets, fill adapters, dispenser components, and monitoring systems. For each item, the inspector indicates whether it passes inspection or needs repair by circling options. Any necessary corrective work or repairs must be noted. Inspectors must sign and date the checklist, which is kept on record for at least 3 years.

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    Visual Monthly Inspections: Underground Storage Tank Systems

    Uploaded by

    Parth Patel
    29 views2 pages
    This document provides a checklist for monthly visual inspections of underground storage tank systems. It lists 17 items to inspect, including vent risers, spill buckets, fill adapters, dispenser components, and monitoring systems. For each item, the inspector indicates whether it passes inspection or needs repair by circling options. Any necessary corrective work or repairs must be noted. Inspectors must sign and date the checklist, which is kept on record for at least 3 years.

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    This document provides a checklist for monthly visual inspections of underground storage tank systems. It lists 17 items to inspect, including vent risers, spill buckets, fill adapters, dispenser components, and monitoring systems. For each item, the inspector indicates whether it passes inspection or needs repair by circling options. Any necessary corrective work or repairs must be noted. Inspectors must sign and date the checklist, which is kept on record for at least 3 years.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views2 pages

    Visual Monthly Inspections: Underground Storage Tank Systems

    Uploaded by

    Parth Patel
    This document provides a checklist for monthly visual inspections of underground storage tank systems. It lists 17 items to inspect, including vent risers, spill buckets, fill adapters, dispenser components, and monitoring systems. For each item, the inspector indicates whether it passes inspection or needs repair by circling options. Any necessary corrective work or repairs must be noted. Inspectors must sign and date the checklist, which is kept on record for at least 3 years.

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    © All Rights Reserved
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    Operator’s Checklist

    Visual Monthly Inspections


    Underground Storage Tank Systems
    RSA 146-C:19 and Env-Or 406.18 require monthly and annual visual inspections by or under the direction
    of the Class A or B operator at an Underground Storage Tank facility.

    Date of Inspection: UST Facility ID Number:


    Facility Name:
    Name of Class B operator directing the inspection:
    Name of person conducting inspection:
    Signature of person conducting the inspection:

     if true ;  if false; Y to indicate corrective work was completed; N/A if not applicable
    Tank # (See OneStop for correct tank numbers):
    (1) Each vent riser shows no visible damage.
    Repaired?
    (2) Each pressure/vacuum vent cap and/or rain cap shows no visible damage.
    Replaced?
    (3) Each spill bucket shows no presence of oil, water, or debris.

    Removed and disposed of content in accordance with all


    applicable federal, state, and local requirements?

    (4) For double-walled spill buckets, including single-walled buckets installed within single-
    walled sumps, gauge indicates no oil or water, or electronic sensor is not in alarm.
    **Must be conducted for triennial tightness testing exemption, per Env-Or 406.12(e)**

    Removed and disposed of content in accordance with all


    applicable federal, state, and local requirements? Repaired?

    (5) Each fill adaptor cap, whether coaxial, two-point fill adaptor cap, and/or dry break adaptor
    cap is not loose, and shows presence of a gasket and tightness of fit.

    (circle one) Tightened, repaired or replaced?


    (6) Each fill adaptor, whether coaxial, two-point fill adaptor, and/or dry break adaptor shows
    tightness of fit,
    (circle one) Tightened or replaced?
    (7) Each fill pipe was free of any obstruction.
    Obstruction Removed?
    (8) Each dry break poppet valve shows a continuous seal, that depresses evenly across the
    valve seat, and reseats properly.
    (circle one) Repaired or replaced?

    August 15, 2019


    Tank #:
    (9) Each motor fuel dispenser hose shows no tears, leaks, holes, kinks, crimps or defects of any
    kind.
    (circle one) Repaired or Replaced?
    (10) Each motor fuel dispenser nozzle shows no leak or defects of any kind.
    (circle one) Repaired or Replaced?
    (11) **Annually for All Dispenser Sumps and Cabinets** Each motor fuel dispenser cabinet
    interior and sump shows no evidence of leaking components and shows no oil, water, or
    debris present.
    Last date completed: __________________________
    If checked annually, the last inspection of the dispenser cabinets
    was conducted on ____________________________
    Repair and disposed of content in accordance with all
    applicable federal, state, and local requirements?
    (12) Each oil transfer and dispensing area shows no presence of oil spills.
    Reported and remediate any spill in accordance with all
    applicable federal, state, and local requirements?
    (13) Each oil transfer and dispensing pad area shows no conditions such as open joints,
    cracking, spalling, nozzles extending beyond the pad, or other defects
    (circle one) Repaired or Replaced?
    (14) Each leak, interstitial and product monitoring system enunciation panel is operating
    properly, including monitoring systems also associated with day tanks
    (circle one) Repaired or replaced?
    (15) **Annually for All Containment Sumps** Each containment sump is free of leaking
    components and the presence of oil, water, or debris.
    Last date completed: ____________________________
    Removed and disposed of content in accordance with all applicable
    federal, state, and local requirements? Repaired?
    (16 **Annually for Double-Walled Sumps Only** Each interstitial space is free of
    any oil or water.
    Last date completed: ____________________________
    Removed and disposed of content in accordance with all
    applicable federal, state, and local requirements? Repaired?
    (17) **Annually for Double-Walled Sumps and Spill Buckets Only** Remove and inspect each
    sensor/gauge for proper length and functionality.
    Last date completed: _________________________________________________
    (circle one) Repaired or replaced?

    The certified operator shall document each monthly maintenance inspection, including all findings and repairs made. Please keep this form
    with your records for a period of no less than 3 years.

    Please attached any repair or maintenance notes to this monthly inspection form.

    August 15. 2019

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